This book, consisting on
eleven chapters each dealing with an aspect of “the interaction between
psychiatry and a particular set of social factors”, is based, in part, on
presentations delivered at the 11^th World Congress of Psychiatry
held in Hamburg in August 1999. It is also, as the editors suggest, as much
about society in psychiatry as psychiatry in society. Indeed, as Sartorius
himself has noted, all psychiatry is social; there is, or rather should be, no
need, for a specialist label of social psychiatry.

The editors have brought
together a range of international authors who are eminent, experienced and well
credentialled in their field. And each one takes on a particularly contentious
issue. Thus, this is not a text for those just wishing to learn of the latest
advances in clinical trials or pharmacology or neuro-science, but it is one for
those who wish to consider deeper and fundamental issues that go to the heart
of the place and value of psychiatry in our present world. It places
psychiatry, its concepts and practice, firmly within a social, economic,
political and ethical context. It considers, especially in areas such as
globalization, refugees, mass media and health policy, the ethics, contexts and
consequences of our choices of practice in the world.

Benedetto Saraceno, Shekar
Saxena and Pallab Maulik from the WHO in Geneva argue that the mental health
interventions following conflict are not only becoming more and more pertinent
as the world population of refugees and Internally Displaced Persons grows and
the affluent countries of the West shut their doors to them, but also because
in the past such treatments have been based more on faith than evidence. Glyn
Lewis and Ricardo Araya from the University of Wales draw together the growth
of globalization and the ever-convincing data that poverty and poor mental
health are completely intertwined and so single country initiatives and
policies are no longer sufficient. Olga Cuenca from Communications Consultancy,
Madrid considers the role of the mass media in the production and support of
social constructions of mental illness. She seriously considers the effect of
newspaper headlines and representations in movies and shows again that
psychiatry and society are completely indivisible.

Some of psychiatry’s
cherished nostrums are also challenged, or at least reviewed. Paul Bebbington
from University College London laments that although the principle of providing
community mental health care through multi-disciplinary teams is “generally
accepted ….(still) the best way of doing it remains unclear”. Heinz Katschnig
and Monika Krautgartner from the University of Vienna consider the adoption of
quality of life measures as the therapeutic imperative, rather than the
treatment of symptoms and disorders. Ahmed Okasha from Ain Shams University,
Cairo proposes an ethical practice based negotiation rather than monological
dominance. For him this means “communal and political activity, in the broadest
sense” in a postmodern world shorn of the certainties of the past.

Certainly, some of the
contributions are a little polemical, but that is no bad thing. The authors
want to put forward an argument and stimulate debate, and there is a clearly a
place for this. We do live in a pluralist world and with very few exceptions
this is the tone of the text. What is perhaps most refreshing is the relaxed
and thoughtful approach to topics of serious concern. The authors have
responded to the space and opportunity given to them. These essays intend to
generate debate, not conclude it. That is seen not only as a necessity, but
also as a responsibility. If we are responsible for what we know, then
psychiatry must act on what it knows.

In conclusion it can be said
that any mental health worker, from any discipline, who is interested in the
fundamental concepts that shape our practice will find much food for thought in
this volume. They may not agree with everything that is said, but they find it
hard to argue that these are not issues of concern. Everyone, from a clinical
or academic background, can benefit from a moment of reflection, and this
impressive book provides that space, time and context.

© 2002 Mark Welch

Dr
Mark Welch is currently a Senior Lecturer and Postgraduate Coordinator in The School of
Nursing at the University of Canberra, Australia. His PhD investigated the
representation of madness in popular film, and his other research interests
include the mental health of refugees and victims of torture, and the history
of psychiatric epistemology.

Categories: Philosophical, MentalHealth